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Excellus BlueCross BlueShieldAll Plans · Coverage · Food (Nutrition) · Gastroenterology, Nephrology, Oncology +2 moreMedium impact

Total Parenteral Nutrition (TPN) or Hyperalimentation 11.01.04

Effective date
Feb 19, 2026
Identified
Jun 20, 2026

Summary

Excellus BlueCross BlueShield policy 11.01.04 considers total parenteral nutrition (TPN) medically appropriate for malnourished individuals with listed conditions, including short bowel syndrome, Crohn's disease, cystic fibrosis with malnutrition unresponsive to enteral nutrition, and adult acute necrotizing pancreatitis with inadequate oral intake for longer than a week. Home TPN for intractable hyperemesis gravidarum is considered medically appropriate only when all listed criteria are met, and intradialytic parenteral or intraperitoneal nutrition for end-stage renal disease is considered medically appropriate only as an alternative to regularly scheduled TPN and as an incremental boost in calories. TPN is considered not medically necessary for advanced cancer unresponsive to chemotherapy or radiation, for children who were well-nourished or mildly malnourished undergoing low nutrition-risk oncologic treatment, and for individuals for whom liver transplantation is not feasible and whose prognosis will not change with TPN. The version effective February 19, 2026 is an annual review with policy intent unchanged.

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What to do

Action · 5 steps
01Already effective February 19, 2026: Billing team, for home TPN for intractable hyperemesis gravidarum, claims need documentation that ALL listed criteria are met: the individual has failed step therapy, other potential causes of nausea and vomiting have been ruled out, symptoms, food intake, urinary ketones, urine specific gravity and daily weights are supplied, clinical signs have persisted for three or more weeks, there is documented weight loss and dehydration or electrolyte abnormalities, there has been over five percent weight loss since the beginning of pregnancy with the individual over 14 weeks pregnant, IV or SQ Zofran or Reglan therapy has failed, enteral therapy has failed or is not an option, and the individual has fully consented to the risks of line infection, bacteremia, sepsis, thrombosis, and fetal loss.
02The PICC line must be started by a qualified medical professional in an appropriate clinical setting.
03Home TPN requires that the individual is medically stable and that the individual or caregiver is adequately trained, and the need for continuing TPN must be reassessed periodically.
04For intradialytic nutrition (IDPN or IPN) for end-stage renal disease, claims must show it is used as an alternative to regularly scheduled TPN for an individual who meets TPN criteria and is not the sole source of nutrition.
05Intradialytic nutrition used as an adjunct to regularly scheduled TPN infusions is considered not medically necessary.

Codes mentioned

3656836573B4164B4216B5000B5200B4220B4224B9004B9006B9999S9364S9368

Original notice

Total Parenteral Nutrition (TPN) or Hyperalimentation 11.01.04
excellusbcbs.com · Always check the source before changing claims.
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Related policy hubs

Excellus BlueCross BlueShield policiesGastroenterologyNephrologyOncologyOB-GYNPediatricsCode 36568Code 36573Code B4164Code B4216Code B5000Code B5200Code B4220Code B4224Code B9004Code B9006Code B9999Code S9364Code S9368

Summaries are AI-assisted. Always confirm against the original payer notice.

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